Provider Demographics
NPI:1386119626
Name:DONALDS, TRACEY LYNN
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:LYNN
Last Name:DONALDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7339 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLARDS
Mailing Address - State:MD
Mailing Address - Zip Code:21874-1102
Mailing Address - Country:US
Mailing Address - Phone:443-783-9554
Mailing Address - Fax:
Practice Address - Street 1:7339 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLARDS
Practice Address - State:MD
Practice Address - Zip Code:21874-1102
Practice Address - Country:US
Practice Address - Phone:443-783-9554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR186387163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD$$$$$$$$$OtherSSI